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Tobacco Use Among Adults --- United States, 2005

Four of the Healthy People 2010 objectives* regarding
tobacco use are to reduce the prevalence of cigarette smoking
to 12.0%, cigar smoking to 1.2%, use of smokeless tobacco to 0.4%, and to increase cessation attempts among adult smokers
to 75.0% (1). To assess progress toward achieving these four objectives, CDC analyzed self-reported data from the 2005
National Health Interview Survey (NHIS). This report summarizes the results of these analyses, which indicated lagging progress on
all four objectives. In 2005, approximately 20.9% of U.S. adults were current cigarette smokers, the same percentage as in
2004 (2), suggesting that the 8-year decline in smoking prevalence among adults in the United States might be stalling. In
addition, the findings indicated that, in 2005, an estimated 2.2% of U.S. adults were current cigar smokers, 2.3% used
smokeless tobacco, and 42.5% of current cigarette smokers had stopped smoking for at least 1 day in the preceding 12 months
because they were trying to quit (Figure). To meet the
Healthy People objectives for 2010, full implementation of
effective, comprehensive tobacco-control programs that address both initiation and cessation of tobacco use is needed in all states
and U.S. territories.

The 2005 NHIS adult core questionnaire, which contained questions on cigarette smoking and cessation attempts,
was administered by in-person interview to a nationally representative sample of 31,428 persons from the
noninstitutionalized U.S. civilian population aged
>18 years. The same respondents were administered a supplemental questionnaire on cancer
that contained questions regarding cigar smoking and use of smokeless tobacco (i.e., chewing tobacco and snuff). The
response rate for both the adult core sample and supplemental questionnaire was 69.0%. Data were adjusted for nonresponse
and weighted to provide national estimates of cigarette and cigar smoking, use of smokeless tobacco, and cessation
attempts. Confidence intervals (CIs) were calculated using statistical software to account for the survey's multistage probability
sample design.

To measure cigarette smoking, respondents were asked, "Have you smoked at least 100 cigarettes in your entire life?"
and "Do you now smoke cigarettes every day, some days, or not at all?" Current cigarette smokers had smoked at least
100 cigarettes during their lifetimes and reported smoking every day or some days. Current cigar smokers had smoked at least
50 cigars during their lifetimes and reported smoking cigars every day or some days. Current users of smokeless tobacco had
used chewing tobacco or snuff at least 20 times during their lifetimes and reported using chewing tobacco or snuff every day
or some days. Among current cigarette smokers, making at least one cessation attempt in the preceding year was defined as
a "yes" response to the question, "During the past 12 months, have you stopped smoking for more than one day because
you were trying to quit smoking?"

In 2005, an estimated 20.9% (45.1 million) of U.S. adults were current cigarette smokers; of these, 80.8% (36.5
million) smoked every day, and 19.2% (8.7 million) smoked some days. The prevalence of current cigarette smoking
varied substantially across population subgroups (Table). Current smoking was higher among men (23.9%) than women
(18.1%). Among racial/ethnic groups, American Indians and Alaska Natives had the highest prevalence (32.0%), followed by
non-Hispanic whites (21.9%), and non-Hispanic blacks (21.5%). Asians (13.3%) and Hispanics (16.2%) had the lowest rates.

By education level, smoking prevalence was highest among adults who had earned a General Educational
Development (GED) diploma (43.2%) and those with 9--11 years of education (32.6%); prevalence generally decreased with
increasing education. Adults aged 18--24 years (24.4%) and 25--44 years (24.1%) had the highest prevalences. The prevalence of
current smoking was higher among adults living below the poverty level (29.9%) than among those at or above the
poverty level (20.6%) (Table).

Certain populations had already surpassed the 2010 target of 12% for current cigarette smoking prevalence.
These included Hispanic (11.1%) and Asian (6.1%) women, women with undergraduate (9.6%) or graduate (7.4%) degrees,
men with undergraduate (11.9%) or graduate (6.9%) degrees, men aged
>65 years (8.9%), and women aged
>65 years (8.3%) (Table).

Among current cigarette smokers, an estimated 42.5% (95% CI =
+1.7; 19.2 million) had stopped smoking for at least
1 day during the preceding 12 months because they were trying to quit. Among the estimated 42.5% (91.8 million) of
persons who had smoked at least 100 cigarettes during their lifetimes, 50.8% (46.5 million) did not smoke currently. In
2005, prevalence of current cigar smoking was 2.2% (CI =
+0.2) and current smokeless tobacco use was 2.3% (CI =
+0.3). Prevalence of cigar smoking and use of smokeless tobacco were higher among men (4.3% and 4.5%, respectively) than
women (0.3% and 0.2%).

Editorial Note:

The findings in this report indicate that the prevalence of cigarette smoking among U.S. adults did
not change from 2004 to 2005. The adult prevalence might represent a stall in the decline in current cigarette smoking during
the preceding 8 years and mirrors a lack of decline in smoking among adolescents since 2002
(3). Influencing factors might include smaller annual increases in the retail price of cigarettes
(4) anda 26.5% reduction in
fundingfor comprehensive state programs in tobacco control and prevention from 2002 to 2006
(5). Additionally, tobacco-industry advertising
and promotional expenditures, primarily focused on price-discounting strategies, more than doubled from $6.7 billion in 1998
to $15.1 billion in 2003 (6).

The rate of decrease in cigarette smoking among adults is not sufficient to meet the 2010 objective of 12%, and the rates
of improvements are also not sufficient to meet the
objectives for cigar smoking, use of smokeless tobacco, and attempts
at smoking cessation. In addition, prevalence remains high among certain segments of the population. For example, in 2005,
the prevalence was 43.2% among persons with a GED diploma and 32.6% among persons with education levels of 9--11 years.

Effective interventions have been identified for decreasing initiation and increasing cessation, but they have not
been implemented adequately (7,8). Recommended interventions include increases in the unit price for tobacco, mass
media campaigns in combination with other interventions, and community mobilization campaigns to restrict access of minors
to tobacco products in conjunction with enactment and enforcement of stronger retail sales laws and retailer education
(8). Additional recommended interventions include reducing out-of-pocket costs to smokers for effective cessation
therapies, multicomponent interventions (e.g., patient education, individual or group counseling, or nicotine replacement
therapies) that include telephone quitlines, and health-care system changes (e.g., health-care provider reminder systems)
(8).

The findings in this report are subject to at least three limitations. First, estimates for cigarette smoking are based on
self report and are not validated by biochemical tests. However, self-reported data on current smoking status have been
determined to have high validity when compared with measured serum cotinine levels
(9). Second, the NHIS questionnaire is administered in English and Spanish only, which might result in imprecise estimates for racial/ethnic populations unable
to respond to the survey because of language barriers. Third, the small NHIS samples for certain populations (e.g.,
American Indians/Alaska Natives) result in single-year estimates with large confidence intervals.

The lack of progress in reducing tobacco use and increasing cessation
attempts among U.S. adults underscores the need
for increasing measures to establish sustained, comprehensive, evidence-based tobacco-control programs that address
both initiation and cessation. Full implementation of these programs at CDC-recommended levels of funding would
accelerate progress toward meeting the 2010 objectives and decreasing the health burden and
economic impact of tobacco-related diseases
(7,8).

References

US Department of Health and Human Services. Healthy people 2010 (conference ed, in 2 vols). Washington, DC: US Department of Health
and Human Services; 2000. Available at
http://www.health.gov/healthypeople.

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Department of Health and Human Services. CDC is not responsible for the content
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